Digital Care That Fits: Tailored Physiotherapy for Patients with Hip and Knee Osteoarthritis

Osteoarthritis (OA) represents the most prevalent musculoskeletal joint disorder globally, with hip and knee joints most commonly affected. Demographic changes including population ageing, rising obesity prevalence, and sedentary lifestyles are projected to substantially increase its individual and societal burden. Current clinical practice guidelines consistently recommend exercise therapy, patient education, and physical activity promotion, predominantly delivered by physiotherapists, as the first-line conservative management. Nevertheless, adherence remains suboptimal, partly attributable to pain-related fear-avoidance behaviours. Furthermore, considerable inter-individual variability in treatment response underscores the limitations of standardised, non-tailored approaches and highlights the need for more tailored care strategies.
The overarching objective of this thesis was to develop, adapt, and evaluate tailored (digital) care strategies for patients with hip and/or knee OA, in accordance with established principles for the design and evaluation of digital physiotherapy interventions. To address this overarching research aim, multiple studies were conducted throughout the thesis, each contributing to the advancement of evidence-based physiotherapy care in OA management.
A case vignette study was conducted to assess physiotherapists' clinical decision-making and guideline adherence. Although the majority of respondents selected evidence-based treatment options, a substantial minority favoured passive modalities such as manual therapy and massage, and only approximately half demonstrated awareness of current OA clinical practice guidelines. These findings indicate persistent gaps in knowledge translation within physiotherapy education and clinical practice.
Two digital interventions were subsequently evaluated. The first, Join2Move, is a self-directed smartphone application delivering an exercise, education, and physical activity programme without direct therapist supervision. Evaluation of this intervention demonstrated promising short-term reductions in pain, suggesting potential utility as a low-threshold self-management tool.
The second intervention, SmArt-E, constitutes a blended care programme integrating a smartphone application with scheduled in-person physiotherapy consultations. SmArt-E was evaluated in a large multicentre randomised controlled trial over a 12-month follow-up period. Compared to usual care, the SmArt-E intervention did not yield statistically significant or clinically meaningful improvements in the primary outcomes of pain and physical function at 12 months. However, secondary analyses at the three-month timepoint revealed statistically meaningful improvements in self-efficacy, physical capacity, and activity planning among SmArt-E participants, suggesting that blended care may exert beneficial effects on psychosocial and behavioural determinants of health in the short term.
Collectively, these findings suggest that digital physiotherapy interventions hold genuine clinical potential, yet current implementations require further refinement and more systematic tailored patient-treatment matching to realise their full benefit. The absence of significant long-term effects in the SmArt-E trial may reflect insufficient tailoring to individual patient characteristics, needs, and stages of disease management. Future research should prioritise the development and validation of stratification tools capable of identifying patient subgroups most likely to benefit from digital or blended care modalities, and at which point along the clinical trajectory such interventions are most appropriately introduced. Advancing precision in treatment allocation represents a critical next step toward optimising physiotherapy outcomes in OA management.